Estimation of the diagnostic accuracy of organ electrodermal diagnostics.

OBJECTIVE: To estimate the diagnostic accuracy and the scope of utilisation of a new bio-electronic method of organ diagnostics. DESIGN: Double-blind comparative study of the diagnostic results obtained using organ electrodermal diagnostics (OED), with clinical diagnosis as the criterion standard. SETTING: Department of Surgery, Helen Joseph Hospital, Johannesburg. PATIENTS: Two hundred pre-selected inpatients of mean age 38 years (standard deviation 9 years) with suspected pathology of one (or more) of the following organs: oesophagus, stomach, gallbladder, pancreas, colon, kidneys, urinary bladder and prostate. In total, 714 of the abovementioned internal organs were selected for statistical consideration. MAIN OUTCOME MEASURES: The degree of rectification of the measuring current once the resistance 'breakthrough effect' has been induced in the skin, as well as the difference in impedance measured at organ projection areas (OPAs) (skin zones corresponding to particular internal organs). RESULTS: In total, 630 true OED results were obtained from the 714 subjects considered, with a detection rate of 88.2% (95% confidence interval (CI): 85.6 - 90.5%). Established OED sensitivity was 89.5% (CI: 85.2 - 92.8%) and OED specificity equalled 87.5% (CI: 84.0 - 90.4%). The predictive value for positive OED results was 81.7% (CI: 76.9 - 85.9%) and for negative OED results 93.0% (CI 90.1 - 95.2%). Healthy organs usually produced the OED result 'healthy' or 'within normal limits', while subacute pathology displayed 'subcute' and acute pathology 'acute'. The OED results were not affected by either the type or the aetiology of disease, i.e. OED estimated the actual extent of pathological process activity within particular organs but did not directly explain the cause of pathology. CONCLUSIONS: So-called OPAs do exist on the skin surface. Pathology of a particular organ causes a related OPA to rectify electrical currents once the resistance 'breakthrough effect' has been induced in the skin. Pathology of an internal organ also increases the impedance of the corresponding OPA. The degree of rectification or difference in impedance is proportional to the extent of the pathological process within this organ. OED which utilises the abovementioned electrical phenomena of the skin, is a reliable bio-electronic method of non-invasive medical diagnostics, with high rates of sensitivity, specificity and predictive values. OED may be used to detect diseased organs and estimate the extent of pathological process activity.

Hyperparathyroidism and chronic pancreatitis.

Hyperparathyroidism is a rare cause of pancreatitis. The nature of the relationship between the two entities is not well defined, i.e. is it casual or causal? We describe 2 patients with chronic pancreatitis and hyperparathyroidism who presented with epigastric pain and were initially treated unsuccessfully by surgical drainage of the pancreatic ducts. In 1 case the hyperparathyroidism was only recognised after the pancreatic surgery. In both the symptoms of chronic pancreatitis responded well to parathyroidectomy. We believe that our cases add support to a causal relationship between pancreatitis and hyperparathyroidism. Whatever the true relationship, management of these patients should initially be directed at the hyperparathyroidism, followed by appropriate treatment of the pancreatitis.

Diagnostic accuracy of organ electrodermal diagnostics. A pilot study.

OBJECTIVE: To estimate the diagnostic accuracy as well as the scope of utilisation of a new bio-electronic method of organ diagnostics. DESIGN: Double-blind comparative study of the diagnostic results obtained by means of organ electrodermal diagnostics (OED) and clinical diagnoses, as a criterion standard. SETTING: Department of Surgery, Helen Joseph Hospital, Johannesburg. PATIENTS: 70 pre-selected inpatients of mean age 36 (SD = 7) years with suspected pathology of one (or more) of the following organs: oesophagus, stomach, duodenum, biliary tract, pancreas, colon, kidneys and urinary tract. In total, 276 of the abovementioned internal organs were selected for statistical consideration. MAIN OUTCOME MEASURES: The difference between the so-called basic electrical impedance of the skin and the impedance value established for a particular organ projection area (the skin zone corresponding to a particular internal organ). RESULTS: In total 250 true OED results were obtained from the 276 subjects considered: detection rate 90.6% (95% CI 87.1-94.1%). Established OED sensitivity was 91.8% (95% CI 88.6-95.0%) and OED specificity equalled 89.9% (95% CI 86.4-93.4%). The predictive value for positive OED results was 83.3% (95% CI 78.9-87.7%) and for negative OED results 95.2% (95% CI 92.0-98.4%). The OED results were affected neither by the type nor the aetiology of disease, i.e. OED estimates the actual extent of the pathological process within particular organs but does not explain the cause of pathology directly. No side-effects of the OED examinations were observed. CONCLUSIONS: So-called organ projection areas do exist on the skin surface. The electrical impedance of the projection areas corresponding to diseased organs is increased, relative to that of healthy organ-related skin zones. The difference in impedance is proportional to the intensity of the pathological process. OED, which utilises these electrical phenomena of the skin, may detect diseased organs and estimate the extent of pathological process activity within these organs.

Gallium scintigraphy in the diagnosis and total lymphoid irradiation of Takayasu's arteritis.

Takayasu's arteritis (TA) in children causes appreciable morbidity and mortality, predominantly as a result of the complication of renovascular hypertension (RVH). Ten children with TA, complicated by RVH, were treated at our centre over the past decade. An initial raised erythrocyte sedimentation rate (ESR) and a purified protein derivative greater than 15 mm were present in every case. More recently, gallium scintigraphy has been used to demonstrate sites of active inflammation in affected vessels (3/4 patients) which became negative after total lymphoid irradiation (TLI). The latter was used in the last 6 children, and appeared to be effective in controlling disease activity as evinced in the normalisation of their ESRs and negative findings on gallium scintigraphy (in all 3 patients with prior active inflammation). Because of vascular damage caused by the vasculitic process, surgical intervention is often required to improve organ perfusion, particularly of the kidney/s. Renal autografting (or allografting) seems preferable (6/11 kidneys functional) to renal bypass grafting (5/5 kidneys clotted). Patient survival improved when TLI was used in addition to standard surgical and medical therapy; this included steroids and antituberculous therapy with TLI, and steroids and cyclophosphamide in the two relapses. Five of 6 patients treated with TLI were alive after 32-54 months' follow-up, while 4 patients who received standard medical and surgical therapy but not TLI all died within 18 months of diagnosis. Gallium scintigraphy is a helpful diagnostic tool in assessing vasculitic activity in TA; TLI is an important mode of immunosuppression, but still needs to be compared with cyclophosphamide as the major immunosuppressive.

Distal splenorenal shunt for non-cirrhotic variceal bleeding in black South Africans.

Distal splenorenal shunt (DSRS) is a once-only form of treatment. It is suitable for many black South Africans with non-cirrhotic variceal bleeding who cannot attend repeated follow-up sclerotherapy sessions. However, persistent hyperbilirubinaemia and encephalopathy may occur following DSRS in schistosomiasis. Forty-one consecutive patients with DSRS have been treated over a 7-year period. The causes of portal hypertension were schistosomiasis (32), portal vein thrombosis (8) and diffuse nodular hyperplasia (1). Operative mortality was 6%. Encephalopathy was observed in 1 patient. Galactose elimination capacity (GEC) and technetium-diethylenetriamine penta-acetic acid hepatic perfusion index (HPI) were used to assess liver function and hepatic perfusion pre- and postoperatively, respectively, in schistosomiasis. GEC was 348 +/- 37 (M +/- SD) before, compared with 343 +/- 67 postoperatively (P = 0.78). HPI showed long-term preservation of hepatopetal portal venous flow following DSRS. Morbidity and mortality were observed only in patients with schistosomiasis associated with hepatitis B chronic active hepatitis. DSRS is ideal treatment in selected patients with non-cirrhotic variceal bleeding.

Gunshot wounds of the colon: role of primary repair.

This is a prospective study of 100 patients with bullet injuries of the colon. Primary repair was performed except in cases of severe colonic damage requiring colectomy or in the presence of disseminated gross peritoneal contamination. Primary repair was performed in 76% with an incidence of abdominal sepsis of 11.8%. The remaining 24% of the patients had a colostomy and the incidence of abdominal sepsis was 29.2% (P < 0.05). Left-sided colonic injuries, multiple colonic perforations, shock on admission, delay > 6 h, more than two associated intra-abdominal injuries, high Injury Severity Score (ISS), and high Penetrating Abdominal Trauma Index (PATI), are not in themselves contraindications for primary repair.

Management options for pancreatic pseudocysts.

Between July 1987 and February 1990, 42 patients with pancreatic pseudocysts were treated. In 83% the pseudocyst was related to alcohol. Patients were managed by observation (7), surgical external drainage (7), and internal drainage (12). Fifteen patients were treated by ultrasound guided percutaneous catheter drainage (UGPCD) with apparent success in 67%. In 5 of these UGPCD was abandoned because of either prolonged drainage or infection of the pseudocyst. In patients with recurrent pseudocysts or in those with failed UGPCD, the cystic collections were successfully drained internally in 16 out of 17 patients (94%). Internal drainage appears to be acceptable treatment for mature pseudocysts, recurrent pseudocysts or for failed UGPCD, provided there is no downstream pancreatic duct obstruction or duct dilatation. If either exist, resection or direct ductal drainage will be required.

Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study.

The aim of this study was to investigate the controversial issue of the use of prophylactic antibiotics in open and basilar fractures of the skull. A series of 157 patients were randomized to receive no antibiotics (group A = 46 patients) or ceftriaxone for 3 days (group B = 50 patients), or the combination ampicillin/sulphadiazine for 3 days (group C = 61 patients). The incidence of meningitis was similar in both the antibiotic and non-antibiotic groups. However, the overall incidence of infectious complications in the non-antibiotic group was significantly higher than in the antibiotic group (8.7 per cent vs 0.9 per cent, P < 0.05). There was no significant difference between the ceftriaxone group and the ampicillin/sulphadiazine group. The results of the study suggest that antibiotic prophylaxis has a role in the management of open and basilar fractures.

The significance of the carotid bifurcation angle in carotid body tumours.

This is a retrospective report on 22 patients with carotid body tumours (intercarotid paragangliomas or carotid chemodectomas) treated by excision using either the dissection technique or en bloc resection. The type of operation to be carried out can be predicted pre-operatively by measuring the carotid bifurcation angle or degree of splaying of the carotid arteries. An angle of less than 90 degrees implies that the tumour can be dissected off the internal carotid artery. An angle of more than 90 degrees implies that it will probably require en bloc resection, including the carotid bifurcation, followed by carotid reconstruction.

Gunshot wound of the abdomen: role of selective conservative management.

This prospective study includes 146 patients with gunshot wounds of the abdomen. One hundred and five patients (72 per cent) had an acute abdomen on admission and were operated on immediately. The remaining 41 patients (28 per cent) had minimal or equivocal abdominal signs and were observed with serial clinical examinations. Seven of the observed patients needed subsequent laparotomy, but there was no mortality or serious morbidity. Had a policy of mandatory exploration for abdominal gunshot wound been applied the incidence of unnecessary or negative laparotomies would have been 27 per cent. By using a policy of selective conservatism this figure was only 5 per cent. We suggest that abdominal gunshot wounds should be assessed and managed exactly like knife wounds. Physical examination is reliable in detecting significant intra-abdominal injuries. Many carefully selected patients with abdominal gunshot wounds can safely be managed non-operatively.